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We invited the 930 patients who met the selection criteria to participate in the study. Patients who consented to participate (n = 200 [21.5%]) did not differ from nonparticipants in age (mean age, 36.6 years vs. 35.8 years; P = 0.27) or socioeconomic status (living in an underprivileged area, 5.0% vs. 7.1%; P = 0.29), but they did differ in sex (women, 69.5% vs. 59.7%; P = 0.012). Baseline characteristics of the randomization groups were similar (Table 2).

The minimal important difference for the Asthma Quality of Life Questionnaire is 0.5, with higher scores indicating better quality of life. The minimal important difference for the Asthma Control Questionnaire is 0.5, with lower scores indicating better asthma control. Plotted values are based on complete cases. Error bars indicate 95% CIs. P values are shown for between-group differences in change in scores at 12 months and are from linear mixed-effects models.

Distribution of change in scores for Asthma Quality of Life Questionnaire (top) and Asthma Control Questionnaire (bottom).

δ = 12-month score minus baseline score. The minimal important difference for the Asthma Quality of Life Questionnaire is 0.5, with higher scores indicating better quality of life. The minimal important difference for the Asthma Control Questionnaire is 0.5, with lower scores indicating better asthma control.

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Internet access in a metropolitian asthma disease state management program

Posted on
December 5, 2009

Glenn R. Singer

Broward Health

Conflict of Interest:
None Declared

Internet-Based Self-management Plus Education Compared With Usual Care in Asthma-the Internet Is Not Available to Everyone in 2009

To the Editor: We read with great interest the article by van der Meer and colleagues on Internet-Based Self- management Plus Education Compared With Usual Care in Asthma (1). Certainly, as noted by the authors self management is a key component of asthma care.

Using the internet has the potential to be an important tool for communication and education. We questioned whether this tool would be available with a more diverse population in our Asthma Disease State Management Program at Broward Health, Fort Lauderdale, Florida.

The Asthma Disease State Management Program at Broward Health is responsible for the care and treatment of unfunded patients within a population of 1 .7 million people. We previously demonstrated that intervention using a case manager approach improved quality of life and reduced expenditure in an asthma population (2).

We surveyed 152 asthma patients who are currently in our asthma program. Patients are referred to the program by emergency department and hospital case managers. We asked these patients what means of communication are available for introduction to disease state management and subsequent education. Options were mail, cell or land line telephone, internet and face to face meetings.

Communication Options Table I

MAIL TELEPHONE INTERNET FACE TO FACE Literature sent to all 152 patients Called all 152 patients 1 Patient (0.7%) had internet access Attempts were made to contact all 152 patients for person to person asthma education appointments 30 letters were returned due to wrong address 18 (12%) were non-working numbers 33 (24%) were met in person

35 (23%) were not answered

38 (25%) were answered by patient, parent, or guardian

49 (32%) were left messages on answering service

12 (8%) were answered by relative or friend

These results highlight the challenges to asthma education and follow up in an urban setting. In a culturally diverse disease state management program, case managers may need to employ methodologies other than internet to help with education and appropriate use of controller medications.

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